Title V Maternal and Child & Adolescent Health Title V MCAH Overview.pdfThe federal Maternal and...
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Title V Maternal and Child & Adolescent Health Serving Iowa’s women, children, adolescents, and families Iowa Department of Public Health Bureau of Family Health
Title V Maternal and Child & Adolescent Health Title V MCAH Overview.pdfThe federal Maternal and Child Health program was authorized in 1935 under Title V of the Social Security Act
Title V Maternal and Child & Adolescent HealthServing Iowa’s women, children, adolescents, and families
Iowa Department of Public HealthBureau of Family Health
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Presentation Notes
Welcome to the Maternal and Child & Adolescent Health Overview training module! The purpose of this module is to provide an overview of the Title V Maternal and Child & Adolescent Health Programs. Concepts that we will feature include: - The purpose of the Title V program - Federal and state level structure for the program - Primary funding for Iowa’s Maternal and Child & Adolescent Health programs - Services under Maternal and Child Health programs as presented by the MCH Pyramid - An overview of the Maternal and Child Health national and state performance measures - The Iowa Department of Public Health’s application process - Required program reports and - Helpful resource information for the Maternal and Child & Adolescent Health programs
Presenters• Stephanie Trusty, Nurse Clinician
– Bureau of Family Health, Maternal Health Program– Email: [email protected]– Phone: (515) 418-7604
• Janet Beaman, Executive Officer 2– Bureau of Family Health, Child & Adolescent Health Program– Email: [email protected]– Phone: (515) 745-2728
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Presentation Notes
Presenters for this module will be Stephanie Trusty and Janet Beaman. Our contact information is included in the event that you have questions pertaining to the content presented today.
Title V of the Social Security Act• Title V funding: Key source of support for promoting and improving
the health and well-being of the nation’s mothers, children, including children with special needs, and their families.
• Vision: An America where all children and families are healthy and thriving and have a fair shot at reaching their fullest potential.
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Since its inception, the Maternal and Child Health (MCH) Services Block Grant (Title V of the Social Security Act) has provided a foundation for ensuring the health of our nation’s mothers and children. Although Title V has been frequently amended over the years, its underlying goal has remained constant. Title V funding is a key source of support for promoting and improving the health and well-being of the nation’s mothers, children, including children with special needs, and their families. Its vision is an America where all children and families are healthy and thriving, and have a fair shot at reaching their fullest potential. MCHB relies on evidence-based strategies and monitors their effectiveness through data-driven means.
History of Title V• The federal Maternal and Child Health (MCH) Program
was authorized in 1935 under Title V of the Social Security Act . Its roots, however, go back nearly a century - to the 1912 creation of the Children's Bureau.
• MCH Block Grant is a federal-state partnership that supports the development of community-based solutions to health threats facing women, children, and families.
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The federal Maternal and Child Health program was authorized in 1935 under Title V of the Social Security Act . Its roots, however, go even further -- back nearly a century -- to the 1912 creation of the Children's Bureau. The Maternal and Child Health Block Grant is a federal-state partnership that supports the development of community-based solutions to health threats facing women, children, and families.
Title V MCH Goals• Access to quality health care for mothers and children, especially for
people with low incomes and/or limited availability of care• Health promotion efforts that seek to reduce infant mortality and the
incidence of preventable diseases, and to increase the number of children appropriately immunized against disease
• Access to comprehensive prenatal and postnatal care for women, especially low-income and/or at-risk pregnant women
• An increase in health assessments and follow-up diagnostic and treatment services, especially for low-income children
• Access to preventive health care services for children as well as rehabilitative services for those in need of specialized medical care
• Family-centered, community-based systems of coordinated care for children with special healthcare needs
• Toll-free hotlines and assistance in applying for services for pregnant women with infants and children who are eligible for Medicaid
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Title V funds are distributed to grantees from 59 states and jurisdictions. The funds seek to create federal and state partnerships that support: Access to quality health care for mothers and children, especially for people with low incomes and/or limited availability of care Health promotion efforts that seek to reduce infant mortality and the incidence of preventable diseases, and to increase the number of children appropriately immunized against disease Access to comprehensive prenatal and postnatal care for women, especially low-income and/or at-risk pregnant women An increase in health assessments and follow-up diagnostic and treatment services, especially for low-income children Access to preventive health care services for children as well as rehabilitative services for those in need of specialized medical care Family-centered, community-based systems of coordinated care for children with special healthcare needs Toll-free hotlines and assistance in applying for services for pregnant women with infants and children who are eligible for Medicaid
Federal Structure for MCHPublic Health Service
Department of Health and Human Services(DHHS)
Health Resources Services Administration(HRSA)
Maternal and Child Health Bureau(MCHB)
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This schematic presents the program organizational structure and the origin of Title V MCH funding at the Federal level. From the overarching Public Health Service, program responsibility and funding flows through the Federal Department of Health and Human Services (DHHS), to the Health Resources and Services Administration (HRSA), and on to the Federal Maternal and Child Health Bureau (MCHB).
Federal Maternal and Child Health Bureau (MCHB)• MCHB promotes
– maternal/women’s health– perinatal and infant health– child health– adolescent and young adult health– children and youth with special health care needs
• MCH provides special focus on– families with low income levels– those with diverse racial and ethnic heritages – those living in rural and isolated areas with limited access to
care
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The Federal Maternal and Child Health Bureau (MCHB) promotes maternal/women’s health to improve women's health before, during and beyond pregnancy. More than 50% of all pregnant women in the U.S. benefit from MCHB programs. perinatal and infant health to ensure that babies are born healthy. More than one-third of all babies born in the U.S. benefit from MCHB programs. child health to ensure that the nation's children are healthy and thriving. More than one-third of all U.S. children benefit from MCHB programs. adolescent and young adult health to improve the health and well-being of America's youth. Millions of youth benefit from MCHB programs. children and youth with special health care needs. Support and services are provided for more than 2 million children and youth with special healthcare needs in the U.S. MCH provides special focus on families with low income levels those with diverse racial and ethnic heritages those living in rural and isolated areas with limited access to care
Title V Block Grant in IowaAdministered by DHHS HRSA MCHB• Granted to state health departments through a formula-
based block grant.– In Iowa, this comes to the Iowa Department of Public
Health.
• It is a $3 billion federal-state partnership.– Matching requirement: States must match at least $3 for
every $4 in federal funds received.
• 37% of Iowa’s Title V funding goes for children and youth with special health care needs.
– In Iowa, this goes to Child Health Specialty Clinics at the University of Iowa
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Title V block grant funds are granted to state health departments and are allocated according to a formula. This formula is based upon the number of children in poverty in the state in relation to the total number of children in poverty nationally. In Iowa, these funds come to the Iowa Department of Public Health. The funding is a federal-state partnership. State matching funds are required in the amount of $3 for every $4 of federal funds received. Local MCH agencies must match $1 for every $4 of grant funds received. The Federal government requires that a minimum of 30% of Title V funds serve children and youth with special health care needs. In Iowa, we set aside 37% of the Title V Block Grant for this purpose. This is designated in state law. These funds go to the University of Iowa’s Child Health Specialty Clinics.
Iowa’s Title V Block Grant• Promotes the health of pregnant women, children, and
youth by facilitating access to preventive health services, especially for low-income families and families with limited access.
• Promotes the development of community-based systems of medical and oral health care for pregnant women, children, youth, and young adults.
• Places an increased emphasis on serving adolescents:MCAH
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Iowa’s Title V Block Grant: Promotes the health of pregnant women, children, and youth by facilitating access to preventive health services, especially for low-income families or families with limited access to health services. Promotes the development of community-based systems of medical and oral health care for pregnant women, children, youth, and young adults. Places an increased emphasis on serving adolescents. In Iowa, we refer to the Maternal and Child & Adolescent Health (MCAH) program.
Iowa’s Structure for MCAHIowa Department of Public Health
(IDPH)
Division of Health Promotion and Chronic Disease Prevention (HPCDP)
Bureau of Family Health (BFH)
Child Health Specialty Clinics (CHSC)
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This schematic presents the program organizational structure and flow of funding for Maternal and Child & Adolescent Health (MCAH) at the state level. Program responsibilities and funding originates with the Iowa Department of Public Health. Funds are allocated to Child Health Specialty Clinics at the University of Iowa for children with special health care needs. The majority of the funding flows through the Division of Health Promotion and Chronic Disease Prevention and to the Bureau of Family Health for program implementation.
Primary Funding Sources for Iowa MCAH Services
Federal Department of Health and Human Services
Iowa Department of Human Services
Iowa Department of Public Health
Interagency Agreement
Title VTitle XIX
Maternal Health Centers & Screening Centers
Contract
Title V MH and CAH Agencies
Other Local Providers
Subcontract
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There are two primary funding sources that support local MCAH programs – Title V Grant funds and Medicaid revenue. Both funding streams originate in the Federal Department of Health and Human Services. Title V Block Grant dollars go to the Iowa Department of Public Health and are contracted to local MCAH agencies through a competitive grant application process. Medicaid funding (Title XIX) is available to local MCAH agencies as they bill for services provided to Medicaid enrolled clients. Services are billed to IME for the Medicaid fee-for-service population and to the Medicaid Managed Care Organizations for the Medicaid MCO enrolled clients. These are services included in Medicaid’s Maternal Health Center and Screening Center provider packages. The Medicaid program is administered at the Federal level by the Centers for Medicare and Medicaid Services (CMS). At the state level, Medicaid is administered by the Iowa Department of Human Services, Iowa Medicaid Enterprise (IME). The majority of funding from the Title V Block grant is distributed to local agencies to build community capacity to deliver services to women and children throughout their service area. They also support services for the uninsured and under-insured population. MCAH agencies may choose to enter into subcontracts and agreements with other local health providers to support local systems of care.
Maternal and Child & Adolescent Health Services
Medicaid’s Maternal Health Center and Screening Center programs provide the model of services for ALL CLIENTS served through MCAH programs.
– Screening Center guidelines are based upon Bright Futures, 4th Edition (AAP - American Academy of Pediatrics)
– Maternal Health Center guidelines are based upon Guidelines for Perinatal Care (AAP/ACOG – American Congress of Obstetricians and Gynecologists)
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All children, adolescents, and pregnant women served through the MCAH program receive the same standard of care – regardless of whether Title XIX or Title V funds are paying for the service. Medicaid’s Maternal Health Center and Screening Center programs provide the model of services for all clients served through MCAH programs. - Screening Center guidelines are based upon Bright Futures, 4th Edition (AAP - American Academy of Pediatrics) Maternal Health Center guidelines are based upon Guidelines for Perinatal Care (AAP/ACOG - American Academy of Pediatrics/American Congress of Obstetricians and Gynecologists)
Member’s Medicaid Status• Medicaid Managed Care Organizations (MCOs)
– Clients either choose or are assigned to a Medicaid MCO whose role is to ‘manage the member’s care’.
– Clients access care from providers enrolled in their MCO.– Claims for MCAH direct care services provided by Title V agencies are billed to
the MCO in which the client is enrolled.– All Medicaid covered dental direct care services provided by Title V agencies
are billed to the IME for any Medicaid enrolled client.
• Fee-for-service (FFS)– Any practitioner enrolled in Medicaid may provide health care services.– Claims for MCAH direct care services provided by Title V agencies are billed to
IME for Medicaid fee-for-service clients. – All Medicaid covered dental direct care services provided by Title V agencies
are billed to the IME for any Medicaid enrolled client.
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Clients are designated by the Iowa Department of Human Services as to whether they are a Medicaid fee-for-service or Medicaid MCO client. A vast majority of Iowans are enrolled under one of the MCOs operating in the state of Iowa. Medicaid MCO Clients either choose or are assigned to a Medicaid MCO. The MCO is contracted by DHS to manage the Medicaid member’s care. Clients enrolled in a Medicaid MCO must access care from providers who are enrolled with that MCO. Claims for MCAH direct care services provided by Title V agencies are billed to the MCO in which the client is enrolled. Medicaid FFS Some Medicaid enrolled clients are assigned as Medicaid FFS. Proportionally, this applies to a small percentage of Iowa’s Medicaid population. A vast majority of Iowa’s Medicaid members choose or are assigned to an MCO. Medicaid FFS clients are able to access care from any provider who is enrolled as a Medicaid provider. Claims for MCAH direct care services provided by Title V agencies are billed to the IME for Medicaid FFS clients. All Medicaid covered dental direct care services provided by Title V agencies are billed to the IME for a any Medicaid enrolled client (whether fee-for-service or MCO designated). Title V direct care dental services are all billed through Medicaid’s fee-for-service system. Agency staff may determine a client’s Medicaid status by checking ELVS – Medicaid’s Eligibility Verification Service (515-323-9639 (locally in Des Moines) or 1-800-338-7752 (toll-free). You may use either the phone system or the on-line portal. Electronic Data Interchange Support Services (EDISS). Above is a link to the EDISS Web Portal
Assuring Member Rights Under Medicaid• Client confidentiality
• Freedom of choice of health provider within the member’s Medicaid status
• Right to appeal to Iowa Medicaid or MCOs– Iowa Department of Human Services
Appeals Section1305 E Walnut Street, 5th FloorDes Moines, IA 50319Phone (515) 281-3094FAX (515) 564-4044Email: [email protected]://dhs.iowa.gov/appeals/appeal-a-dhs-decision
– Contact the assigned MCO regarding their appeal process.
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Medicaid members are assured certain rights under the Medicaid program. HIPAA is the Health Insurance Portability and Accountability Act of 1996. Regarding client confidentiality, Title V MCAH agencies must comply with HIPAA regulations. For example, messages left during informing and care coordination contacts must maintain Medicaid confidentiality. It would be appropriate to reference ‘health care coverage’ but not appropriate to state ‘Medicaid coverage’. The same is true for notes left at the door when making a home visit when the family is not home. Do not put ‘Medicaid’ on the outside of envelope or any note left at the door. However, referencing the ‘Care for Kids program’ or ‘health insurance’ is acceptable. It is important for agency staff to remember confidentiality practices and include these in program protocols. Medicaid members have the right to file an appeal if they choose. Examples may include: Being terminated from Medicaid coverage and the client believes this is incorrect. The client wants services and prior authorization is denied. Information on Iowa’s Medicaid Appeal Process can be found at https://dhs.iowa.gov/appeals/appeal-a-dhs-decision. If you have questions specific to the appeal process, the client may also contact their Medicaid income maintenance worker. They will be able to answer your questions, but will not be able to give legal advice. For legal help, Medicaid members may want to contact an attorney, or Iowa Legal Aid at 1-800-532-1275. If they live in Polk County, call (515) 243-1193. Contact the member’s assigned MCO regarding their appeal process. When a managed care network provider disagrees with an action taken by the managed care organization, the provider may file an appeal on behalf of a Medicaid member, if the member has given written consent for the provider to do so.
MCAH Electronic Record System• TAVConnect is the official record for all MCAH services.
– Child and Adolescent Health Services must be entered into the TAV- CAH module.
– Oral Health services must be entered into the TAV-OH module.
– Maternal Health services must be entered into the TAV-MH module.
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In 2016, Iowa’s Maternal and Child & Adolescent Health programs began development of a new electronic data system through a contract with a company known as TAVHealth. The data system is called TAVConnect. All Child and Adolescent Health services provided by Title V agencies must be entered into the TAVConnect – CAH module. This module went live April 1, 2017. All oral health services must be entered into the TAV-OH module which also went live on this same date. - All Maternal Health services provided by Title V agencies must be entered into the TAVConnect – MH module. This module went live June 1, 2017.
The Title V MCH Pyramid of Services
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This slide presents the nationally recognized Title V Maternal and Child Health (MCH) Pyramid of Services. This pyramid serves as the conceptual framework for the services of the Title V Maternal and Child Health Block Grant. It aligns with the 10 essential services of public health and consists of three levels. These levels are: -Public Health Services and Systems -Enabling services -Direct Health Care services. We will address each level individually.
Public Health Services and Systems• Community needs assessment / data analysis / strategic planning
• Developing and reviewing protocols
• Developing and maintaining community linkages – providing information on the MCAH program to local providers
• Hiring of personnel and staff training
• Establishing subcontracts and agreements
• Quality assurance and quality improvement
• Program evaluation
• Population-based services
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Public Health Services and Systems Public health services and systems are activities and infrastructure to carry out the core public health functions of assessment, assurance, and policy development, and the 10 essential public health services. Examples include the development of standards and guidelines, needs assessment, program planning, implementation, and evaluation, policy development, quality assurance and improvement, workforce development, and population-based disease prevention/public education/health promotion campaigns (e.g. related to injury prevention, breastfeeding promotion, safe-sleep education, anti-smoking).
Enabling Services• Outreach
– Presumptive eligibility for pregnant women and children– Reaching hard-to-reach populations– Health fairs
• Informing services– For families of newly eligible Medicaid children– Provides information on Medicaid’s EPSDT benefits
• Care coordination services– Linking to maternity care or periodic well child exams and related diagnosis treatment– Work with medical, dental, mental health, and other providers on behalf of clients– Arranging interpretation and transportation services
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Enabling Services Enabling services are non-clinical services that enable individuals to access health care and improve health outcomes. Enabling services require effective communication strategies with families. Methods include telephone contacts, face-to-face visits, and written correspondence. Local MCAH agencies are required to have extended hours outside of the 8:00 a.m. – 5:00 p.m. work day to accommodate working families. Agencies may establish flexible schedules for selected staff. Enabling services include, but are not limited to, outreach, informing families of newly eligible children of their Medicaid EPSDT (Early Periodic Screening, Diagnosis, & Treatment) benefits, care coordination, making referrals, arranging interpretation and/or transportation services, eligibility assistance, and health literacy initiatives. Local MCAH agencies consider health literacy when developing written materials for their clients. Agency staff consider reading levels and language barriers. They also provide access to services for individuals with disabilities.
Direct Services• Primary and preventive services through a medical/dental home
• Gap-filling direct care services provided by MCAH agencies– Prenatal Risk Assessment– Maternal health education– Psychosocial services– Depression screening– Domestic violence screening– Drug/alcohol screening– Immunizations– Blood lead tests– Developmental and emotional/behavioral screening– Dental screens– Fluoride varnish applications
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Direct Services Direct care health services comprise the smallest tip of the MCH Pyramid. These are preventive, primary, or specialty clinical services for pregnant women, children, and adolescents. Typically, maternal and child & adolescent clients access direct care services through private medical and dental providers within local communities. Title V agencies strive to assure that clients have an established medical home and dental home where services are comprehensive, patient-centered, coordinated, accessible, and focused on quality and safety. However, preventive direct health care services may be supported by MCAH program funds when gaps in service provision are clearly identified. If providing direct antepartum and postpartum medical care OR full well child exams, MCAH agencies must demonstrate that barriers exist in their service area for accessing these services. Currently no MH agencies are providing antepartum and postpartum medical care. Only limited CAH agencies provide full well child exams for a small segment of their population. Nearly all MCAH agencies provide some level of gap-filling direct care health services. Examples of gap-filling direct care services include: -Prenatal Risk Assessment -Maternal health education -Psychosocial services -Depression screening -Domestic violence screening -Drug/alcohol screening -Immunizations -Blood lead tests -Developmental and emotional/behavioral screening -Dental screens -Fluoride varnish applications
National and State Performance Measures
(NPM and SPM)
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The Title V Block Grant requires states to report on a variety of performance measures each year as they submit their application for MCH funding to the federal level. Included are National Performance Measures which are designed to capture standardized performance and health outcome data across all states. In addition, states are required to identify their own state-level priorities by establishing state performance measures. Some performance measures pertain only to children with special health care needs. For the purpose of this module, our focus will be on those measures that pertain more broadly to the MCAH population. Starting in 2015, Iowa conducted a state-wide needs assessment to identify priorities for serving women, children, and adolescents. This resulted in the selection of new national performance measures and identification of new state performance measures. These measures provided the direction for Iowa’s MCAH program for the 2016-2020 federal fiscal years.
Iowa’s Title V National Performance MeasuresNPM # Data Source Performance Measure MCH Population Domain
PM 1 BRFSS Percent of women with a past year preventative visit Women/Maternal
PM 4 National Immunization Survey A) Percent of infants ever breastfedB) Percent of infants breastfed exclusively through 6 months
Perinatal/Infant
PM 6 NSCH – revised Percent of children, ages 9-71 months, receiving a developmental screening using a parent-completed screening tool
Child Health
PM 9 YRBSS & NSCH Percent of adolescents, ages 12-17 years, who are bullied Adolescent Health
PM 10 NSCH – revised Percent of adolescents with a preventive services visit in the last year Adolescent Health
PM 11 NSCH – revised Percent of children with and without special health care needs having a medical home CSHCN
PM 12 NSCH – revised Percent of children with and with special health care needs who received services necessary to make transitions to adult health care
CSHCN
PM 13 A) PRAMS B) NSCH-revised
A) Percent of women who had a dental visit during pregnancy andB) Percent of infants and children, ages 1-17 years, who had a preventive dental visit
in the last year
Cross-cutting
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Following completion of Iowa’s MCAH Needs Assessment, eight National Performance Measures were selected. These include: NPM #1: The percent of women with a past year preventive visit NPM #4: A) The percent of infants ever breastfed B) The percent of infants breastfed exclusively through 6 months NPM #6: The percent of children, ages 9-71 months, receiving a developmental screening using a parent-completed screening tool NPM #9: The percent of adolescents, ages 12-17 years, who are bullied You may notice emphasis on serving adolescents. This resulted in changing the name of Iowa’s MCH program to specifically include adolescents: Maternal and Child & Adolescent Health (MCAH) Program. NPM #10: The percent of adolescents with a preventive services visit in the last year NPM #11: The percent of children with special health care needs having a medical home NPM #12: The percent of children with and without special health care needs who received services necessary to make transitions to adult health care NPPM #13: A) The percent of women who had a dental visit during pregnancy B) The percent of infants and children ages 1- 17 years who had a preventive dental visit in the last year You will notice that measures pertain to different domains – women’s heath, maternal health, perinatal/infant health, adolescent health, and children with special health care needs. Some are cross-cutting which may impact any of these domains. Remember that these measure are consistent across those states that selected them. This means that data can be compared across states for these National Performance Measures.
Iowa’s Title V State Performance MeasuresSPM # Performance Measure MCH Population Domain
SPM 1 Percent of children and youth with special health care needs who meet the criteria for Quality of Care
CYSHCN
SPM 2 A) Percent of Child Health clients who report a medical homeB) Percent of Maternal Health clients who report a medical home
Cross-cutting
SPM 3 Percent of children with a payment source for dental care Child Health
SPM 4 Percent of early care and education programs that receive child care nurse consultant services Child Health
SPM 5 Rate of physical activity among adolescents aged 18-24 Adolescent Health
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In addition to the National Performance Measures, each state is also required to select measure of their own. These are the five State Performance Measures. Iowa selected the following: SPM #1: The percent of children and youth with special health care needs who meet the criteria for Quality of Care. This measure applies specifically to children and youth with special health care needs. The University of Iowa administers this component of Iowa’s Title V program. SPM #2: A) The percent of child and adolescent health clients who report a medical home B) The percent of maternal health clients who report a medical home SPM #3: The percent of children with a payment source for dental care SPM #4: The percent of early care and education programs that receive child care nurse consultant services SPM #5: The rate of physical activity among adolescents aged 18-24 Again, you can see that these measures apply to a variety of domains: children with special health care needs, child health, maternal health, and adolescent health. One measure is cross-cutting and applies to multiple domains. For State Performance Measures, each state selects their own measures and establishes parameters for capturing data. Therefore, the data for SPMs is not comparable across states.
Iowa’s MCAH Application Process• A Request for Proposal (RFP) process establishes the foundation
for the upcoming project period (FFY 2017 through FFY 2020).
• A Request for Application (RFA) is a continuation application submitted in each subsequent year of the project period (FFY 2018, FFY 2019, and FFY 2020).
• Upon approval, a MCAH contract is issued.– Special conditions for the MCAH Program.– General Conditions that apply to all IDPH contracts.
Go to http://idph.iowa.gov and click on ‘Funding Opportunities’.
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In Iowa, local MCAH agencies are established through a competitive grant application process. A Request for Proposal (RFP) process establishes the foundation for an upcoming project period. The RFP involves a competitive application. The RFP was issued for FFY 2017, and the current project period extends from FFY 2017 through FFY 2020. A Request for Application (RFA) is a non-competitive continuation application. This is submitted for each subsequent year of the project period. For example, RFAs are issued for FFY 2018, FFY 2019, and FFY 2020 for this project period. Upon approval of either an application or proposal, a contract is issued. Contracts include two components: -Special conditions for the MCAH Program -General Conditions that apply to all IDPH contracts. These are found at http://idph.iowa.gov. Click on ‘Funding Opportunities’.
The Local MCAH Application• Establishes the MCAH program plan for each county in the service
area. – Required activities identified in the guidance (e.g. BOH and NPM/SPM)– Program priorities based upon community needs, including CHNA & HIP– Optional activities
• Logic Models provide a program summary – MH, CAH, OH
• It includes:– Activity Worksheets– Service Delivery Tables– Program Budgets
• Are submitted through IowaGrants.gov.
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Each agency’s MCAH application establishes the local program’s plan for serving women/children/adolescents/families in each county in the service area. It addresses: -Required activities established in the guidance -Program priorities based upon community needs. This would include any MCAH related needs identified in the Community Health Needs Assessment & Health Improvement Plan (CHNA & HIP) for the counties in the service area. -Optional activities Some activities are required that address selected National and State Performance Measures. Local agencies may also select additional optional performance measures on which to focus their activities. Activities are also required for reporting to each county Board of Health in the service area. This is important because the county board of health has jurisdiction over public health matters in the county per Iowa Code 137.5. The county Board of Health is the official local health authority. Local agencies are required to provide MCAH program information and receive suggestions for program improvement from each county local BOH in their service area. The Maternal Health / Child & Adolescent Health / and Oral Health Logic Models present a program outline and present MCAH required and optional performance measures. The application includes the following primary components: -Activity Worksheets -Service Delivery Table -Program Budgets Applications are submitted through IowaGrants.gov.
IowaGrants.gov Grant Site• All documentation of contract activities are
captured on the agency’s grant site in IowaGrants.gov. Components include:
– Application– Contract and amendments– Correspondence– Posting of claims– Cost Analysis – Service Note Review– Site Visit– Reports (e.g. Chart Audits, Mid-Year Report, Year
End Report)
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Each contract year, a grant site is established for each MCAH contract agency. This is the official site for posting all grant related documents for the fiscal year. Included on this site are: Your grant application including its various components Your MCAH contract and any amendments Contract related correspondence Claims Your agency’s annual Cost Analysis (required each year to identify your agency’s costs for providing each MCAH service). Service Note Review This is a review of documentation of presumptive eligibility, informing, and care coordination services in TAVConnect – conducted twice a year. Documentation of site visits conducted by IDPH Reports Examples include: MH and CAH Chart Audits which involve a review of clinical documentation of direct care services. There are joint audits by agency and state staff in one year, followed by internal chart audits by the local agency staff in the alternate year. A Mid-Year Report which provides a reflection of progress on proposed activities. A Year End Report which involves a report on activities from your agency’s application. It also includes reporting on key data indicators. It is important that information on this site be updated throughout the federal fiscal year as needed (such as Key Personnel, Subcontracts, any modifications to activities -- which may be made if approved by July 15 of the fiscal year.)
Billing of MCAH Services• Always bill your agency’s cost -- determined by the Cost Analysis
completed at the beginning of the fiscal year.
• IME, Medicaid MCOs, and IDPH reimburse your agency’s cost for the service billed – up to a maximum rate.– Claims go to IDPH for presumptive eligibility, informing, and care coordination
services.– Claims go to IME for direct care services for Medicaid fee-for-service clients. Oral
health direct care claims for all Medicaid clients go to IME.– Claims go to the Medicaid MCOs for direct care services for clients enrolled in the
MCOs (except for MH and CAH dental services).
• Assure that date of service on billing records matches the date of service in TAVConnect and the clinical record.
• Be sure that documentation of services is complete for any service billed.
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Regarding billing of services for the Maternal and Child & Adolescent Health programs: -Always bill your agency’s cost determined by the Cost Analysis. This is completed at the beginning of each fiscal year. -The Iowa Medicaid Enterprise (IME), the Medicaid Managed Care Organizations (MCOs), and the Iowa Department of Public Health reimburse your agency’s costs up to a maximum established rate. Claims go to IDPH for presumptive eligibility, informing, and care coordination services. Claims go to IME for direct care services for Medicaid fee-for-service clients. Oral health direct care claims for all Medicaid clients go to IME. Claims go the Medicaid MCOs for direct care services for clients enrolled in the MCOs (except for dental services). -Assure that date of service on billing records matches the date of service TAVConnect and in the clinical record. Auditors typically review individual claims based upon the date of service. It is important that the date of service in the client record matches the date of service on the claim. The documentation on that date must be sufficient to support the service billed on that same date. -Be sure that documentation of services is complete for any service billed.
MCAH Project Management Portal• Designed for MCAH agencies to access relevant program
• Tools include:– Cost Analysis and Transportation Plan– Maternal Health Services Summary– Child & Adolescent Health Services Summary– Logic Models– Chart Audit Guidelines and Tools– DHS Rules for Documenting Services– Service Note Review– Consent and Release of Information Templates– Trainings for CAH Informing, Care Coordination and Direct Care Services– And MORE!
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A number of tools are needed in order to carry out requirements of the MCAH program. These tools are posted on the ‘MCAH Project Management Portal’ -- with the listed website link. Postings on this site include: - Resources for completing the Cost Analysis and Transportation Plan - Maternal Health Services Summary Child & Adolescent Health Services Summary MCAH program Logic Models - Chart Audit Guidelines and Tools DHS Iowa Administrative Code Rules for documenting services Guidelines for Service Note Review Templates for Consent for Services and Release of Information forms On-line trainings for CAH Informing, Care Coordination and Direct Health Care services - And MORE!
• Member Services 800-338-8366 (toll free)515-256-4606 (Des Moines area)
• Eligibility Verification System (ELVS)800-338-7752 (toll free)515-323-9639 (Des Moines area)
or via the web portal through EDISS.
• IA Health Link: https://dhs.iowa.gov/iahealthlink
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IDPH enters into an agreement with Iowa Medicaid each year that provides the foundation for the funding available to local MCAH agencies through their Medicaid Maternal Health Center and/or Screening Center status. This collaborative relationship provides the opportunity for regular communication with staff from the Iowa Medicaid Enterprise (IME) on program-related issues. Medicaid is a vital funding source for MCAH programs, as Medicaid covered services are billed to the IME for Medicaid fee-for-service clients or Medicaid MCOs for Medicaid MCO enrolled clients. Resource information for the Iowa Medicaid Enterprise is found on this slide. Note that eligibility for a given date for a client may be accessed via phone or 24/7 through the Electronic Data Information Support Services (EDISS). Use your agency’s log in and password to use the EDI portal. To find information on Iowa’s Medicaid Managed Care Program, go to the website for IA Health Link. Contact the Medicaid MCO for questions relating to services for their clients.
For More Information• The Chief of the Bureau of Family Health serves as Iowa’s Title V
Director.
• Your agency’s Regional MCAH Consultant and/or Oral Health Consultant serve as primary contacts for program information.
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Assistance is available whenever you have questions regarding Iowa’s MCAH program. The Bureau Chief for the Bureau of Family Health serves as Iowa’s Title V MCH Director. Key contacts for program information and questions are your local agency’s Regional Consultants. The state is divided into 6 regions. An agency consultant is assigned for your MCAH program and also for your OH program.
Resources• IDPH Family Health: http://idph.iowa.gov/family-health
• HRSA Maternal and Child Health Bureau: https://mchb.hrsa.gov/
• HRSA Title V MCH Block Grant: https://mchb.hrsa.gov/maternal-child-health-initiatives/title-v-maternal-and-child-health-services-block-grant-program
• Association of Maternal and Child Health Programs (AMCHP): http://www.amchp.org/pages/default.aspx
• National Performance Measure Data: https://mchb.tvisdata.hrsa.gov/
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Key MCAH program links are listed on this slide. They include: The IDPH Bureau of Family Health’s webpage. Program information can be accessed for Maternal Health and also for Child & Adolescent Health. HRSA’s federal Maternal and Child Health Bureau site Information from the federal level on the Title V MCH Block Grant The Association of Maternal and Child Health Programs (AMCHP). This is the national MCH advocacy organization. Information on National Performance Measures – including Iowa data.
